Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging.

Abstract

A phase-contrast cine magnetic resonance (MR) imaging technique was used to study normal dynamics of cerebrospinal fluid (CSF) in 10 healthy volunteers and four patients with normal MR images. This pulse sequence yielded 16 quantitative flow-encoded images per cardiac cycle (peripheral gating). Flow encoding depicted craniocaudal flow as high signal intensity and caudo-cranial flow as low signal intensity. Sagittal and axial images of the head, cervical spine, and lumbar spine were obtained, and strategic sites were analyzed for quantitative CSF flow. The onset of CSF systole in the subarachnoid space was synchronous with the onset of systole in the carotid artery. CSF systole and diastole at the foramen of Monro and aqueduct were essentially simultaneous. The systolic and diastolic components were different in the subarachnoid space, where systole occupied approximately 40% and diastole 60% of the cardiac cycle, compared with the ventricular system, where they were equal. This difference results in systole in the intracranial and spinal subarachnoid spaces preceding that in the ventricular system; the same is true for diastole. The fourth ventricle and cisterna magna serve as mixing chambers. The high-velocity flow in the cervical spine and essentially no flow in the distal lumbar sac indicate that a portion of the capacitance necessary in this essentially closed system resides in the distal spinal canal.

The formation of cerebrospinal fluid: Nearly a hundred years of interpretations and misinterpretations

“…But during the examined period, CSF permanently pulsated near the external end of the plastic cannula, the flow of the CSF volume (circulation) did not exist and not a single drop of CSF was observed in the collection tube in any of the investigated animal. These results closely corresponded to some results observed by the MR imaging technique on humans Enzmann and Pelc, 1991) and the results obtained by a similar method on cats (Orešković et al, 2001). To test the sensitivity of the method, i.e.…”

Correlation of diffusion tensor imaging and phase-contrast MR with clinical parameters of cervical spinal cord injuries

“…18,19 Cine phase-contrast flow methods can image and perhaps quantify CSF pulsatile flow. 5,20 To the best of our Figure 4 Peak systolic and diastolic velocities of CSF in normal controls and SCI patients. Significant differences between increased peak systolic velocities at injury level in SCI patients and significant decreased peak diastolic velocities in SCI patients at below level (*Po0.05).…”

“…23 The reported CSF flow velocities in normal control volunteers are between 0.7 cm s − 1 (diastole) and 1.3 cm s − 1 (systole) in the midsagittal plane, 24 and between 2.3 cm s − 1 (diastole) and 2.1 cm s − 1 (systole) in the axial plane. 20 Patients with Chiari I malformations were reported to have peak systole/diastolic CSF velocities in the foramen magnum of 11.7/11.6 cm s − 1 , compared with velocities of 4.9/5.9 cm s − 1 in normal controls. 24 Increased systolic velocities were observed in our SCI patient group at the level of maximum compression, the smallest area of the anterior SAS.…”

Physiology-Based MR Imaging Assessment of CSF Flow at the Foramen Magnum with a Valsalva Maneuver

“…4,6 However, these methods have not gained widespread acceptance because they are invasive. Although noninvasive assessment of CSF flow pulsations by MR imaging that measure bidirectional CSF flow from pressure changes between the head and spine during a cardiac cycle 7,8 can be used as a surrogate, all but one of the prior implementations of cine-PC MR imaging for CSF flow assessment required approximately 100 heartbeats, making it too long to use with a transient physiologic challenge. As a result, most cine-PC studies of CSF flow have only been used during quiet breathing, both in healthy participants and in patients with suspected CSF circulation abnormalities.…”